U.S. Published patent application No. 2005/0276401, which names Madill, Jr., et al. as inventors, discloses a computer system that is pertinent prior art to the present invention. Among other functions, Madill's computer system may run software that appraises the likelihood that an insurance claim is fraudulent. One aspect of Madill's software encompasses a predictive model that compares a current claim with a fraud model generated from historical data that reflects past claims that were found to be fraudulent. In the one specific type of fraud model described in Madill's application, fraud patterns are detected among claimants, witnesses, medical providers, attorneys, repair facilities, etc.
The present inventor has recognized that the utility of a proactive referral model, for determining whether certain long term disability claims should be identified as potentially questionable and referred for special investigation, can be significantly enhanced by appropriate selection of certain variables to be used in building the proactive referral model.